BACKGROUND: The impact of serial imaging on the outcome of ICU patients has not been studied specifically in patients with high illness severity. METHODS: The authors sought a relationship between the numbers of antero-posterior supine chest X-rays (CXR), computed tomography (CT) examinations, and outcome in a cohort of 292 patients with severe COVID-19 ARDS collected over 24 months in a high-volume ECMO center with established ultrasound and echocardiographic diagnostics. Of the patients, 172 (59%) were obese or morbidly obese, and 119 (41%) were treated with ECMO. RESULTS: The median number of CXRs was eight per 14 days of the length of stay in the ICU. The CXR rate was not related to ICU survival (p = 0.37). Patients required CT scanning in 26.5% of cases, with no relationship to the outcome except for the better ICU survival of the ECMO patients without a need for a CT scan (p = 0.01). The odds ratio for survival associated with ordering a CT scan in an ECMO patient was 0.48, p = 0.01. The calculated savings for not routinely requesting a whole-body CT scan in every patient were 98.685 EUR/24 months. CONCLUSIONS: Serial imaging does not impact the survival rates of patients with severe ARDS. Extracorporeal membrane oxygenation patients who did not need CT scanning had significantly better ICU outcomes.

• Keywords
• COVID-19 pneumonia, acute respiratory distress syndrome, barotrauma, chest X-ray, chest computer tomography, chest ultrasonography, extracorporeal membrane oxygenation, pneumothorax,
• Publication type
• Journal Article MeSH

• MeSH
• Drainage MeSH
• Respiratory System MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * MeSH
• Pleural Effusion * diagnostic imaging   therapy   MeSH
• Ultrasonography MeSH
• Check Tag
• Humans MeSH
• Publication type
• Letter MeSH

The mechanism of re-expansion pulmonary oedema (Re-PE) is unclear. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. We present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of Re-PE. The transthoracic echocardiography (TTE) showed an ejection fraction of 38%, moderate mitral regurgitation (MR), mildly dilated right ventricle and moderate pulmonary hypertension. A pleural tap evacuated 850 mL of transudate, which was followed by tachypnoea and deteriorating oxygenation. Another repeat TTE revealed a Re-PE with elevated left ventricular end-diastolic pressure, severe MR, increased pulmonary hypertension and a decrease in stroke volume. There were no parallel changes in ventilation modality, heart rate, fluid therapy and vasopressor dosage. The treatment was initiated with dobutamine. The patient was extubated the next day and was later discharged to the cardiology department.

• Keywords
• adult intensive care, heart failure, lung function, mechanical ventilation,
• MeSH
• Dobutamine therapeutic use   MeSH
• Drainage adverse effects   MeSH
• Echocardiography MeSH
• Ventricular Function, Left MeSH
• Cardiotonic Agents therapeutic use   MeSH
• Blood Pressure MeSH
• Humans MeSH
• Mitral Valve Insufficiency etiology   MeSH
• Pleural Effusion therapy   MeSH
• Lung physiopathology   MeSH
• Pulmonary Edema drug therapy   etiology   MeSH
• Hypertension, Pulmonary etiology   MeSH
• Respiratory Insufficiency therapy   MeSH
• Aged MeSH
• Heart physiopathology   MeSH
• Heart Ventricles pathology   MeSH
• Heart Failure complications   MeSH
• Stroke Volume MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Dobutamine MeSH
• Cardiotonic Agents MeSH